ABSTRACT
Prostate volume has been reported to have an effect on the severity of pain during prostate biopsy. This study assessed the effect of prostate volume on pain during TRUS guided prostate biopsy when apical peri-prostatic block is compared with intra-rectal xylocaine gel. This was a prospective randomized study which involved 90 patients. Group (A) had 2% intra-rectal plain xylocaine gel instillation, while Group (B) had peri-prostatic block with 1% plain xylocaine infiltration. Both groups were further stratified into prostate volume of < 50 mls and ≥50 mls. An 11 point visual analogue scale was used to assess pain during probe insertion, biopsy and 1 hour after biopsy. The mean pain score analyzed for each group. The mean pain score for Group (A) patients with prostate volume < 50 mls was 3.22.2, 7.31.7 and 2.11.4 during probe insertion, biopsy, and one hour after biopsy respectively. For Group (A) patients with prostate volume ≥50 mls, the mean pain score recorded was 2.81.8, 5.71.6, and 2.31.8 during probe insertion, biopsy and one hour after biopsy respectively (P{during biopsy} = 0.003). For Group B patients, the mean pain score during probe insertion, biopsy and one hour after biopsy for patients with prostate volume < 50 mls was 3.11.8, 2.81.7, 1.00.6 respectively. While for patients with prostate volumes ≥50 mls, the mean pain scores were 2.91.8, 3.21.8 and 1.30.9 respectively. This study revealed that prostate volume did not affect the severity of pain during prostate biopsy when apical peri-prostatic block was used as the anesthetic agent. Significantly reduced pain during trans-rectal ultrasound guided biopsy of the prostate for all prostate volumes. Intra-rectal xylocaine though inferior to peri-prostatic block was more effective for patients with prostate volume ≥50 mls.
